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NHS access requires meeting NICE criteria: BMI 35 kg/m (or 32.5 kg/m for certain ethnic groups) with weight-related comorbidities, referral to specialist weight management services, and demonstrated response to treatment at defined review points

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The conversation with her and her medical team should include the importance of monitoring blood glucose before, during, and, if possible, after exercise sessions, and the recognition that the insulin-independent effect of exercise on glucose uptake is a real and significant clinical variable